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Aunchman, Marvin VIIIIM NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name Firs arvin Middle Ilibbchman I SexMale Date of Death Ag If Veteran of U.S. Armed Forces, 09/17/2015 12 years War or Dates j- Place of Death Hospital, Institution or t? City, Town or Village Town Of Milton Street Address 900 Rock City Rd Lot 66 a Manner of Death©Natural Cause El Accident 0 Homicide D Suicide riUndetermined D Pending tii 'I Circumstances Investigation WMedical Certifier Name Title Q Desmond Delgiacco Md Ad9rtle Street, Saratoga Springs, Ny 12866 Death Certificate Filed District Number Register Number town or MP Milton 4561 38 ❑Burial Date Cemetery or Crematory 09/17/2015 Pine view Cemetery 0 Entombment Address ( Cremation Queensbury N Y Date Place Removed Z Removal and/or Held 2❑and/or Address F= Hold C}- — 0 Date Point of tCh❑Transportation Shipment ES by Common Destination Carrier Q Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Regibsofib4 tion Number Name of Funeral Home Compassionate Funeral Care Address 402 Maple Avenue, Saratoga Springs, Ny 12866 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address ir ut P.`. Permission is hereby granted to dispose of the h ii -n r ains descr.e i -bove as indicated ilk Date Issued 09/18/2015 Registrar of Vital Art171 , , _ ;�& ,_ ('ignature) District Number 4561 Place Milton certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 ill Date of Disposition y/ZiI IC Place of Disposition or.%)— 2 (address) W 0 CC (section) /,/. (lot number)c. (grave number) Ca Name of Sexton or Person in Charg of Premises !4 t, J+i'A ( ease print) iLi Signature Title (tZ 't (over) DOH-1555 (02/2004)